Provider Demographics
NPI:1174774418
Name:CHRZANOWSKI, CONRAD
Entity type:Individual
Prefix:
First Name:CONRAD
Middle Name:
Last Name:CHRZANOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3424 KOSSUTH AVE
Mailing Address - Street 2:ROOM 11C-08
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2410
Mailing Address - Country:US
Mailing Address - Phone:718-519-3914
Mailing Address - Fax:718-519-4845
Practice Address - Street 1:3424 KOSSUTH AVE
Practice Address - Street 2:ROOM 11C-08
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2410
Practice Address - Country:US
Practice Address - Phone:718-519-3914
Practice Address - Fax:718-519-4845
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist